[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Clinical immunological diagnostics of overlap syndrome during autoimmune hepatic disorders].

The complex determination of serum autoantibodies to hepatic antigens using enzyme immunoassay and immunoblot allows to increase the frequency of overlap syndrome identification during autoimmune hepatic disorders and its early diagnostics, that has a big clinical, diagnostic and prognostic importance. The levels of overlap autoantibodies combine with biochemical index and with disease activity and intensity of autoimmune processes during overlap syndrome of primary biliary cirrhosis/autoimmune hepatitis (PBC/AIH).

[Syndrome of overlap of autoimmune hepatitis and primary biliary cirrhosis with the outcome in cirrhosis of the liver, complicated by fatal bleeding in the small intestine].

The authors presents the clinical case of autoimmune overlap syndrome: autoimmune hepatitis and primary biliary cirrhosis with outcomes in the hepatic cirrhosis complicated fatal intestinal bleeding.

[Diagnostic value of serum markers of fibrosis in chronic liver diseases].

AIM: To estimate the diagnostic value (DV) of direct markers of liver fibrosis, such as type IV collagen (C-IV), hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1) in combination with indirect markers of fibrosis, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (gamma-GTP), alkaline phosphatase (ALP), platelets, tumor necrosis factor-alpha (TNF-alpha) in evaluating liver fibrosis. SUBJECTS AND METHODS: Sixty-seven patients with chronic diffuse liver diseases were examined. ALT, AST, gamma-GTP, and ALP were determined as indirect indicators of fibrosis. The levels of TIMP-1, HA, C-IV, and TNF-alpha were estimated by ELISA; the stage of fibrosis was determined by the results of indirect liver ultrasound fibroelastography (FE). RESULTS: According to the results of FE, the patients were divided into 2 groups: 1) (n = 25) F < or = 2 METAVIR and 2) (n = 42) F3-F4. While estimating DV of severe fibrosis stages (F3-F4), the area under the ROC curve (AUC) increased for platelets, HA, and C-IV. DV of ALT, AST declined with the higher degree of fibrosis. The highest ratio of test specificity and sensitivity (TSp and TSen) and AUC were observed for AST and HA. ALT and platelets showed low TSen, and TNF-alpha and TIMP-1 had no TSp. For evaluation of fibrosis (F4), a HA increase of over 57.7 ng/ml had 92.6% TSen and 67.5% TSp; for a C-IV elevation of above 133.1mkg/l, TSen was 85.2%, TSp was 57.5%; for a TIMP-1 rise from 24.4 ng/ml, TSen was 74.1% and TSp was 62.5%. For the diagnosis of fibrosis (F4) with a HA rise of more than 57.7 ng/ml, DV of a positive test was 65.8 (48.65-80.4; 95% CI) and that of a negative test was 93.1 (76.8-99.2; 95% CI). Thus, the negative rather than positive test results are of great diagnostic value for evaluation of the degree of fibrosis. CONCLUSION: The results of the investigation convincingly suggest that examination of the serum markers of fibrosis allows one to estimate with a high probability its presence and severity in patients with hepatic cirrhosis. The so-called direct markers (substances reflecting the biochemistry and regulation of fibrogenesis) are undoubtedly of great diagnostic value.

[Diagnostic value of autoantibodies to asialoglycoprotein receptor in autoimmune hepatitis].

Among 106 patients with autoimmune liver disease in 12 (11.3%) were found autoantibodies to asialoglycoprotein receptor (anti-ASGPR): in 5 (9.1%) of 55 with PBC, and 4 (17.4%) of 23 with AIH and 3 (10.7%) of 28 patients with syndrome chiasm (PBC + AIH). Detection of antibodies against the ASGPR is an effective method for diagnosis of autoimmune hepatitis. Further improvement of this method allows for monitoring and disease. Anti-ASGPR levels correlate with biochemical parameters and with the severity and manifestation autoimmune processes in patients with autoimmune hepatitis.

[Spontaneous bacterial peritonitis in liver cirrhosis: optimization issues of prevention and treatment].

Research of features of a current of a spontaneous bacterial peritonitis (SBP) allows to allocate close interrelation between SBP, system inflammatory reaction and a sepsis to consider SBP, as one of stages in evolution of the difficult infectious process caused, as a rule, by resident flora, developing at patients with decompensated liver cirrhosis (LC), which demands timely preventive maintenance and adequate antibacterial therapy. In the present work therapy and preventive maintenance SBP questions are considered. In article the extensive review of the data of the literature and own supervision by efficiency of treatment SBP also is presented. For the purpose of optimization of pharmacotherapy of the sick LC, the complicated ascites, had been conducted pharmacokinetics research ciprofloxacin (CPF) according to dynamics of its maintenance in blood serum (BS) and ascitic fluid (AF) depending on presence and ascites size. Materials and methods. Researches are spent 18 sick decompensated liver cirrhosis (a class B and C on Ch-P), without signs SBP after unitary reception of 500 mg CPF per os on an empty stomach. All patients have been divided on two groups: I gr. (n = 10) with the expressed, intense ascites (> 10 1) and II gr. (n = 8) with the moderate, small ascites. Definition CPF in BS also was already carried out by a method of a highly effective liquid chromatography. On the basis of the received data for each patient counted the semidelucing period (T1/2), the area under pharmacokinetic curve (curve concentration - time) - (AUC), volume of distribution of a preparation (Avd), factor AUC(AF)\MIC (size of the relation of the area under pharmacokinetic curve to its minimum inhibitive concentration). Results of research have shown that concentration levels (C) (CPF in BS and AF for the given concrete patient are at one level, showing thus distinctions in dynamic behavior. Average value AUC(AF)\MIC (MIC - minimum inhibitive concentration) at patients II gr. has made 187,3 +/- 5,6 h that almost in 2 times more than necessary value, as has allowed not to recommend to patients increase in dose CPF. On the contrary, parity AUC(AF)/MIC at patients I gr. has made 43,8 +/- 3,6 h (less than 100 h) that it is not enough for therapeutic effect. Conclusions. The conducted research has allowed to make the conclusion that presence and ascites size make essential impact on pharmacokinetic parameters CPF and to recommend increase in dose CPF to 1000 mg/days for sick LC with sharply expressed ascites and safe nephritic function.

[Primary non-Hodgkin lymphoma of the liver in patients with chronic virus].

The article provides a brief overview of recent data on non-Hodgkin's lymphoma. We describe a special case primary isolation non-Hodgkin's lymphoma of the liver in a patient with chronic hepatitis C. Were analyzed medical errors at all stages of inspection and treatment of the patient. This exceptional case supplements small number of publications on a problem of the isolated lymphoma of a liver. We also wanted to pay attention once again to need of lifetime morphological research of a liver.

[Features of the HCV-infection in the elderly patients].

The problem of chronic HCV-infection in the elderly patients is poorly known. During the HCV-infection and progression of fibrosis in chronic liver diseases depends on age of the patient.

[Spontaneous bacterial peritonitis: scientific and practical achievements and prospects].

We presented the results of our research in comparison with the literature on the etiology, pathogenesis and diagnosis of spontaneous bacterial peritonitis (SBP) at liver cirrhosis (LC), complicated by ascites. Based on these data, was proposed a classification of SBP. Were identified criteria for early diagnosis of SBP on the basis of clinical manifestations of bacterial peritonitis, systemic inflammatory response, results of studies of ascitic fluid (AF) using gas chromatography-mass spectrometry (GC-MS). In accordance with the proposed criteria was proposed a scheme for the diagnosis, treatment and prevention of STDs. Presents data on the effectiveness of therapy and prevention of SBP. Denote the potential major long-term trends in the treatment of SBP in cirrhosis.

[Spontaneous bacterial peritonitis and systemic inflammatory reaction in hepatic cirrhosis patients].

AIM: To develop criteria of early diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic cirrhosis (HC). MATERIAL AND METHODS: Clinical symptoms of SBP including systemic inflammatory reaction were analysed in 286 patients. The count of polymorphonuclear neutrophils (PNL) in ascitic liquid (AL), microbiological study of the blood and AL were made. Ultrasound investigation assessed acoustic homogeneity of AL. Blood serum (BS) and AL were tested for cytokines content: interleukine-1beta, TNF-alpha, interleukine-4, transforming growth factor beta, C-reactive protein. Gas chromatography--mass spectrometry (GC-MC) estimated quantity and quality of chemical components--markers of potential infectious agents of AL. RESULTS: Three groups of patients were identified: group A (a classic SBP) consisted of 23 patients with clinical symptoms of SBP and PNL content > 0.25 x 10(9)/l; group B (control) consisted of 19 patients free of SBP symptoms and PNL content < 0.25 x 10(9)/l; group C (patients at risk)--18 patients with SBP symptoms and PNL content < 0.25 x 10(9)/l. Cultural test of AL was negative in all the groups. Symptoms of SIR occurred equally often in groups A and C. CRP in AL was higher (23.8 +/- 4.3 g/l) in group A than in group B (p < 0.05). CRP concentration (8.6 +/- 2.1 g/l) was higher in group C than in group B (p < 0.05). Changes in cytokine composition were similar in groups A and C. The number of chemical bacterial markers was higher in groups A and C (p < 0.005). CONCLUSION: Patients of group C with SIR, elevated CRP, changed cytokine status, high content of chemical markers of AL infection by GC-MC are at high risk of SBP. Such patients need adequate and early antibacterial therapy.

[Effectiveness of the new plant hepatoprotector--Ropren in patients with non-alcoholic steatohepatitis].

Liver damage causes serious metabolic disorders, immune response, detoxification functions and antimicrobial protection. Therefore, the problem of finding new high effective drugs for the restoration and normalization of liver function is extremely urgent. This article presents a new domestic plant hepatoprotector Ropren, which is a biopolymer polyprenols isolated from the green of pine and spruce, and an analog of the endogenous lipid--dolichol. Presented the Ropren efficiency in patients with nonalcoholic steatohepatitis. The drug reduces the clinical and biochemical disease activity, contributes to the normalization of lipid profile. The resulting decrease in the index treatment of fibrosis, determined by indirect transient elastometry, indicates an increase in the elasticity of the liver and reducing the risk of developing cirrhosis.

[The diagnostic significance of ultrasound elastometry in evaluation of fibrosis in chronic diffuse liver diseases].

THE PURPOSE OF THE STUDY: Determination of the diagnostic value of ultrasound elastometry of liver (UEL) in the assessment of liver fibrosis in patients with chronic diffuse liver diseases (CDLD). MATERIAL AND METHODS: The study involved 316 patients with various etiologies of the CDLD, with the underwent both liver biopsy, the UEL, and evaluation of fibrosis (F) according to the Metavir classification. RESULTS: The maximum diagnostic accuracy of the UEL was obtained in determining of the 4-th stage of fibrosis according to the Metavir. The accuracy of the method was 91% with a sensitivity of 100%. The lowest sensitivity of the UEL determined in patients with nonalcoholic fatty liver disease (NAFLD): F1 - 25%, F2 - 33%, F3 and F4 - 50%. The High body mass index (BMI = 30,1 +/- 3,8 kg/m2) is a factor which is limiting the use of elastometry for patients NAFLD. The low sensitivity for F1 and F2 - 14,3% and 10%, respectively, 100% for F4, with a BMI = 24,4 +/- 5,1 kg/m2 was obtained in primary biliary cirrhosis (PBC). In the alcoholic liver disease (ALD) obtained high sensitivity (100%) for F2 and F4. In the CDLD of viral etiology the sensitivity of UEL was 33-71,4% in the early stages of fibrosis (F1 and F2) with high specificity - 100% and 93.5% respectively. CONCLUSION: The use of the UEL allows the diagnosis of fibrosis in chronic liver diseases of different etiologies as an alternative to needle biopsy of the liver.

[Autoimmune reactions in diseases of the digestive system organs].

AIM: To examine content, diagnostic and prognostic role of autologous antibodies in gastrointestinal diseases (GID). MATERIAL AND METHODS: Enzyme immunoassay was used to measure content of autologous antibodies to N+/K+ ATPase (Aab) of gastric parietal cells, mitochondria, microsomes, tissue transglutaminase in blood serum of 196 patients with gastric, gallbladder, small and large intestinal diseases. Aab relations with heterologous antibodies were studied with kits provided by Bektor-Best (Novosibirsk), DRG-Diagnostics, Orgentec (Germany) and others. RESULTS: In GID high circulation of Aab to parietal cells (Ab-PC) was detected in 42% cases, mean content being 217 +/- 32.4 U/ml, 10 U/ml in the control. Maximal concentration (180 = 340 U/ml) occurred in hepatic cirrhosis, celiac disease, atrophic gastritis. In exacerbations of pancreatitis, colelithiasis and duodenal ulcer ab-PC concentration was 190-210 U/ml, in remission--6-12 U/ml. Minimal concentration (8-38 U/ml) was seen in polyps, gastric cancer, nonspecific ulcerative colitis. For primary biliary cirrhosis more typical was high A/ab concentration to mitochondria (in 83%; 200 U.ml), for autoimmune hepatitis--Aab to microsomes (in 81%; 170 U/ml), in celial disease--Aab to tissue transglutaminase (93%, 75 U/ml). High autoantibodies concentration in GID is accompanied with overcirculation of heteroantibodies to infectious-toxic agents confirming their role in development of autoimmune processes. CONCLUSION: GID are associated with high circulation of autologous antibodies--markers of systemic humoral autoimmune reactions differing in duration, severity, site of lesion, form, stage, disease duration. Maximal detection rate and concentration of serum autologous antibodies were observed in hepatic cirrhosis, active hepatitis, celiac disease, atrophic gastritis, exacerbations of cholelithiasis, ulcer, pancreatitis. Estimation of Aab concentration is essential for diagnosis, prognosis of autoimmune diseases, it reflects intensity and duration of autoimmune reactions in GID.

[Liver cirrhosis of alcoholic etiology complicated by the spontaneous bacterial peritonitis].

The case of spontaneous bacterial peritonitis (SBP) in the patient, with alcoholic cirrhosis, is presented in the article. Clinical observation demonstrates diagnostic hardships of latent clinical course of alcoholic cirrhosis, complicated SBP. Clinical observation demonstrated diagnostic consequence of ultrasound elastometry.

[Diagnosis of spontaneous bacterial peritonitis in liver cirrhosis].

Working out of the new methodical approaches of diagnostics and treatment of spontaneous bacteriological peritonitis (SBP) in the patients with cirrhosis of the liver (CL). The ascitic liquid (AL) was examined in 35 patients with CL by the method of gas chromatography--mass-spectrometry (GCH-MS). The results of quantitative and qualitative examination of the chemical components--markers of potential infection (aerobe and anaerobe) with the GCH-MS method testify to the infected AL. The proposed method demonstrates the high precision revealing of infected abdominal cavity in the patients with CL and proposes the proper treatment according to the varieties of microorganisms.